Clinical radiology最新文献_第9页

Clinical and MRI findings in patients with pediatric optic pathway glioma presenting with initial leptomeningeal dissemination 小儿视神经通路胶质瘤患者的临床和磁共振成像发现，最初表现为脑膜播散

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-10 DOI: 10.1016/j.crad.2024.10.004

Z.-A. Hwang , K.-H. Chang , Y.-Y. Lee , H.-H. Chen , H.-W. Wu , C.-H. Wu , J.-H. Chen , T.-M. Lin , C.-C. Wu , F.-C. Chang

Aims

Although leptomeningeal dissemination (LMD) is a hallmark of malignant brain tumors, optic pathway glioma (OPG) of various grades can initially present with LMD, which is thenceforth interpreted as an aggressive tumor. In this study, we aimed to evaluate the clinical and imaging findings of pediatric OPG (POPG) patients who presented with initial LMD to ensure a prompt diagnosis and better outcomes.

Materials and Methods

Between 2000 and 2022, 35 pediatric patients with pathologically proven OPG who presented with and without LMD at our institute were retrospectively reviewed. We compared the demographic and histopathology characteristics, magnetic resonance imaging features, and clinical outcomes of the initial LMD group and the non-LMD group.

Results

Compared with those in the non-LMD group (n = 27), POPGs in the LMD group (n = 8) were more symmetrically midline-positioned (75% versus 22.2%, P = .006) and had more ill-defined tumor borders (25% versus 0%, p = .007), and patients were more likely to develop hydrocephalus (100% versus 63%, P = .042). There was no significant difference regarding the histopathology (P = .686) and outcome of tumor recurrence/progression (P = .341). However, the mortality rate was higher in the LMD group than in the non-LMD group (62.5% versus 18.5%, P = .016).

Conclusions

Features of a more symmetrical midline-positioned POPG with indistinct tumor borders and hydrocephalus are risk factors for initial LMD regardless of histopathology. Compared with those without initial LMD, patients with POPG with initial LMD had poorer outcomes, which may suggest the need for a more aggressive treatment protocol.

目的虽然脑膜外播散（LMD）是恶性脑肿瘤的特征之一，但不同级别的视路胶质瘤（OPG）最初也可能表现为LMD，然后被解释为侵袭性肿瘤。在这项研究中，我们旨在评估初次出现 LMD 的小儿 OPG（POPG）患者的临床和影像学检查结果，以确保及时诊断和更好的治疗效果。材料与方法回顾性研究了 2000 年至 2022 年期间我院经病理证实的 35 例小儿 OPG 患者，这些患者有的出现 LMD，有的未出现 LMD。我们比较了初始 LMD 组和非 LMD 组的人口统计学和组织病理学特征、磁共振成像特征和临床预后。结果与非LMD组（n = 27）相比，LMD组（n = 8）的POPG更对称地位于中线位置（75%对22.2%，P = .006），肿瘤边界更不清晰（25%对0%，P = .007），患者更容易出现脑积水（100%对63%，P = .042）。组织病理学（P = .686）和肿瘤复发/进展结果（P = .341）无明显差异。然而，LMD 组的死亡率高于非 LMD 组（62.5% 对 18.5%，P = .016）。结论无论组织病理学如何，中线位置较对称的 POPG、肿瘤边界不清和脑积水是初始 LMD 的危险因素。与无初始 LMD 的 POPG 患者相比，有初始 LMD 的 POPG 患者预后较差，这可能表明需要采取更积极的治疗方案。

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引用次数: 0

“The dilemma of GTN versus benign causes of secondary PPH that were indeterminate by ultrasound examination: How to differentiate?: A new prospective diagnostic criterion of functional MRI and ultrasound" "超声检查无法确定继发性 PPH 的 GTN 与良性病因的难题：如何区分？功能性磁共振成像和超声检查的新前瞻性诊断标准"

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-10 DOI: 10.1016/j.crad.2024.09.024

Y.E.A. Khalifa , S.F. Mohamed , A.M. Abd Allah , H.M. Haggag , E.A. Ali

Objectives

Early differentiation between causes of secondary postpartum hemorrhage (PPH) can sometimes be difficult and can cause serious complications if diagnosis and treatment are delayed. The study aimed to assess the efficacy of different imaging diagnostic criteria, which would help in differentiating between gestational trophoblastic neoplasia (GTN) from indeterminate benign causes; thus, aiding in making clinical decisions in a timely fashion.

Methods

A comparative prospective study, were 33 patients complaining of 2ry PPH, with indeterminate diagnosis referred to the Radiology department female imaging unit between October 2020 and November 2022 for further assessment. Transvaginal ultrasound examination as well as functional MRI was done. The lesions were characterized and certain diagnostic criteria were evaluated.

Results

The lesion epicenter, margin and depth of myometrial invasion detected by dynamic MRI have significant role to differentiate between GTN and other benign conditions mainly RPOC with higher sensitivity, specificity and accuracy of MRI compared to US. The p value, sensitivity and specificity as well as the accuracy of MRI were: 0.006, 50 %, 92 %, and 81.8 %; 0.000, 87.5 %, 92 % and 90.9 %; 0.002, 87.5 %, 92 % and 90.9 % compared to 0.5, 50 %, 64 % and 60.6 %; 0.01, 87.5 %, 64 % and 69.7 %; 0.2, 87.5 %, 40 % and 51.5 % by US respectively. The overall performance of MRI to reach accurate final diagnosis is higher than the US with accuracy rate of 97 % compared to 63.6 % in indeterminate cases.

Conclusions

MRI was found to show higher performance, compared to US in differentiating inconclusive cases of 2ry PPH.

目的继发性产后出血（PPH）病因的早期鉴别有时很困难，如果延误诊断和治疗，可能会引起严重的并发症。本研究旨在评估不同影像学诊断标准的有效性，这些标准有助于区分妊娠滋养细胞肿瘤（GTN）和不确定的良性病因，从而有助于及时做出临床决策。方法一项前瞻性对比研究，在 2020 年 10 月至 2022 年 11 月期间，33 例主诉 2ry PPH 且诊断不确定的患者被转诊至放射科女性影像科接受进一步评估。患者接受了经阴道超声检查和功能性核磁共振成像检查。结果动态磁共振成像检测到的病灶中心、边缘和子宫肌层浸润深度对鉴别 GTN 和其他良性病变（主要是 RPOC）有重要作用，与 US 相比，磁共振成像的敏感性、特异性和准确性更高。核磁共振成像的 p 值、敏感性、特异性和准确性分别为分别为 0.006、50%、92% 和 81.8%；0.000、87.5%、92% 和 90.9%；0.002、87.5%、92% 和 90.9%，而 US 分别为 0.5、50%、64% 和 60.6%；0.01、87.5%、64% 和 69.7%；0.2、87.5%、40% 和 51.5%。磁共振成像在最终准确诊断方面的总体表现高于 US，其准确率为 97%，而在不确定病例中的准确率为 63.6%。

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引用次数: 0

Sex discrimination, sexual harassment, and sexual assault in UK radiology training: a national survey 英国放射学培训中的性别歧视、性骚扰和性侵犯：一项全国性调查

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-09 DOI: 10.1016/j.crad.2024.09.023

E. Robinson , P. Singhal , W. Loughborough , D. Little

AIM

Sex discrimination and sexual misconduct are endemic issues within the National Health Service (NHS). The extent of the problem amongst radiology registrars across the UK is unknown. This national survey explores the experiences of radiology registrars in relation to sex discrimination, sexual harassment, and sexual assault during radiology training, in addition to the impact on wellbeing and barriers to reporting behaviours.

MATERIALS AND METHODS

This observational study using qualitative data from distribution of a national survey with ethical approval.

Results

122 responses were received. A significantly increased proportion of females have witnessed or experienced sex discrimination and sexual harassment compared to males (p < 0.05). A greater proportion of females also experienced sexual assault however the numbers are low and not statistically significant.

The majority of perpetrators (58%) were senior colleagues both from within and outside of the radiology team (including radiology supervisors). 21% of perpetrators were patients.

72% of radiology registrars who experienced sex discrimination, harassment and/or assault were not happy with the way in which their situation was dealt with. 68% were not aware of a pathway in place for reporting such behaviours.

Conclusion

Sex discrimination and sexual harassment and assault have been experienced widely by radiology registrars, disproportionately affecting women. There are significant barriers to reporting these issues especially given most perpetrators are senior colleagues. We call upon responsible organisations to create a safe working environment for all, including implementing new pathways for reporting, developing training, and considering safety measures such as enhanced use of chaperones.

目的性别歧视和性行为不端是国民健康服务系统（NHS）中普遍存在的问题。在英国，放射学注册医师中这一问题的严重程度尚不清楚。这项全国性调查探讨了放射学注册医师在放射学培训期间遭受性别歧视、性骚扰和性侵犯的经历，以及对健康的影响和报告行为的障碍。与男性相比，目睹或经历过性别歧视和性骚扰的女性比例明显增加（p < 0.05）。大多数施暴者（58%）是放射科团队内外的资深同事（包括放射科主管）。72% 遭受过性别歧视、骚扰和/或攻击的放射科注册医师对处理其遭遇的方式不满意。68%的人不知道有举报此类行为的途径。结论放射科注册医师普遍遭受过性别歧视、性骚扰和性侵犯，女性受到的影响尤为严重。报告这些问题存在很大的障碍，特别是考虑到大多数肇事者都是资深同事。我们呼吁负责任的机构为所有人创造一个安全的工作环境，包括实施新的报告途径、开展培训和考虑采取安全措施，如加强使用陪护。

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引用次数: 0

Investigation of brain diffusion changes in children with primary nephrotic syndrome 原发性肾病综合征患儿脑弥散变化研究

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-09 DOI: 10.1016/j.crad.2024.10.003

F. Dogan , K. Yilmaz , H. Gumus , S.S. Karayol , A. Gencler , D. Kose

Aim

Primary nephrotic syndrome, which occurs with the deterioration of kidney function, can subsequently affect the brain with systemic immune activation, vasculopathy and ischemia. The main aim of this study was to investigate the effectiveness of apparent diffusion coefficient (ADC) and diffusion weighted imaging (DWI) in identifying and detecting brain changes in pediatric patients with primary nephrotic syndrome (PNS).

Materials and Methods

The study included 24 pediatric patients with PNS and 60 healthy children as a control group. The apparent diffusion coefficient values of caudate nucleus, frontal cortex, thalamus, lentiform nucleus, anterior crus and posterior crus of the internal capsule, frontal and occipital white matter were measured quantitatively.

Results

The ADC values of thalamus, occipital white matter, caudate nucleus and frontal cortex in the PNS group were significantly lower than in the control group (p < 0.05 for all). No statistically significant difference was detected between the groups with respect of other brain locations.

Conclusion

Systemic effects and possible complications of primary nephrotic syndrome may lead to diffusion changes in brain tissue. The decrease in ADC values in patients with PNS may be explained by decreased cerebral perfusion due to cerebral vasoconstriction and vasculopathy.

目的原发性肾病综合征是随着肾功能恶化而发生的，随后会影响大脑，出现全身免疫激活、血管病变和缺血。本研究的主要目的是探讨表观弥散系数（ADC）和弥散加权成像（DWI）在识别和检测原发性肾病综合征（PNS）儿科患者脑部变化方面的有效性。结果 PNS 组丘脑、枕叶白质、尾状核和额叶皮质的 ADC 值明显低于对照组（P 均为 0.05）。结论原发性肾病综合征的系统影响和可能的并发症可能导致脑组织的弥散变化。原发性肾病综合征患者的 ADC 值下降可能是由于脑血管收缩和血管病变导致脑灌注减少。

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引用次数: 0

RCR meetings RCR 会议

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-09 DOI: 10.1016/S0009-9260(24)00552-X

引用次数: 0

Classifying, recognizing, and troubleshooting errors in magnetic resonance imaging (MRI)-guided breast biopsies. 磁共振成像（MRI）引导的乳腺活组织检查中的错误分类、识别和故障排除。

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-05 DOI: 10.1016/j.crad.2024.09.020

B Tran, A Mobley, S Colvin, S Woodard

MRI-guided biopsies can generate challenging scenarios. Errors can occur for many reasons, both preprocedural and intraprocedural. Radiology errors have been studied for many years, originally classified by Renfrew in 1992 and revised in 2014 by Kim and Mansfield. While classification systems have focused on diagnostic radiology; many can also apply to procedural errors. This review aims to use the Kim-Mansfield modification of the Renfrew error classification system to provide a discussion and review of common MRI-guided biopsy errors to help radiologists manage them efficiently and appropriately.

核磁共振成像引导下的活组织检查可能会产生具有挑战性的情况。发生错误的原因有很多，包括术前和术中。放射学错误已被研究多年，最初由 Renfrew 于 1992 年进行分类，并由 Kim 和 Mansfield 于 2014 年进行修订。虽然分类系统主要针对放射诊断，但许多系统也适用于手术错误。本综述旨在使用 Renfrew 错误分类系统的 Kim-Mansfield 修正版，对常见的 MRI 引导活检错误进行讨论和综述，以帮助放射科医生有效、适当地处理这些错误。

引用次数: 0

The prognostic value of left atrial strain and strain rate in predicting heart failure outcomes in patients with hypertrophic cardiomyopathy and a left ventricular ejection fraction of 50% or higher 左心房应变和应变率在预测肥厚型心肌病和左心室射血分数 50% 或以上患者心力衰竭预后中的价值。

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-05 DOI: 10.1016/j.crad.2024.09.022

Y. Qian , R.-Y. Shi , J.-Y. Zheng , B.-H. Chen , D.-A. An , Y. Zhou , J.-Y. Xiang , R. Wu , L. Zhao , L.-M. Wu

Aim

Identifying high-risk hypertrophic cardiomyopathy (HCM) patients for heart failure (HF) is a challenge. Previous studies noted left atrial (LA) abnormalities in HCM patients, but the predictive value of LA strain and strain rate for HF in those with left ventricular ejection fraction (LVEF) ≥ 50% remains unclear. Our study aimed to explore if LA strain and strain rate predict HF-related outcomes in HCM patients with LVEF ≥ 50%.

Materials and Methods

In this retrospective study, 284 patients aged 51 (range 40–62), 68% male, were studied. 34 experienced HF-related outcomes including death to HF, NYHA III-IV class progression, and HF worsening leading to hospitalization. LA strain and rate were analyzed using cardiac magnetic resonance (CMR) feature tracking technique. ROC curves, Kaplan–Meier curves, violin plot, LASSO analysis, forest plot, and Cox regression were used. The strength of the association was represented as HR∗, where HR∗ is defined as hazard ratio (HR) when the HR > 1 and as 1/HR when HR < 1.

Results

After adjusting for the NYHA classification and the extent of LV-LGE, the booster strain (HR∗: 1.094; 95% CI: 0.845–0.989; p = 0.026) and booster strain rate (HR∗: 2.593; 95% CI: 1.369–4.910; p = 0.003) were significantly associated with HF-related events. Reservoir strain, conduit strain, and their respective strain rates did not emerge as independent predictors for HF-related outcomes.

Conclusion

LA booster strain and strain rate showed a stronger association with HF-related outcomes, highlighting significant functional changes in the LA. Identifying these parameters as key predictors underscores their importance in managing particularly in HCM patients with LVEF ≥ 50%.

目的：识别心力衰竭（HF）高危肥厚型心肌病（HCM）患者是一项挑战。以前的研究注意到 HCM 患者的左心房（LA）异常，但对于左室射血分数（LVEF）≥ 50%的患者，LA 应变和应变率对 HF 的预测价值仍不清楚。我们的研究旨在探讨 LA 应变和应变率是否能预测 LVEF ≥ 50% 的 HCM 患者与 HF 相关的预后：在这项回顾性研究中，284 名患者年龄在 51 岁（40-62 岁之间），68% 为男性。34名患者出现了与心房颤动相关的结果，包括死于心房颤动、NYHA III-IV 级进展和心房颤动恶化导致住院。采用心脏磁共振（CMR）特征跟踪技术对 LA 应变和速率进行了分析。使用了 ROC 曲线、Kaplan-Meier 曲线、小提琴图、LASSO 分析、森林图和 Cox 回归。相关性的强弱用 HR∗ 表示，其中 HR∗ 在 HR > 1 时定义为危险比（HR），在 HR < 1 时定义为 1/HR：在调整了 NYHA 分级和 LV-LGE 的程度后，增压应变（HR∗：1.094；95% CI：0.845-0.989；P = 0.026）和增压应变率（HR∗：2.593；95% CI：1.369-4.910；P = 0.003）与 HF 相关事件显著相关。蓄水池应变、导管应变及其各自的应变率并未成为心房颤动相关结果的独立预测因素：结论：LA增压应变和应变率与心房颤动相关结果有更密切的关系，凸显了LA的显著功能变化。将这些参数确定为关键预测因子，凸显了它们在管理 LVEF ≥ 50% 的 HCM 患者方面的重要性。

{"title":"The prognostic value of left atrial strain and strain rate in predicting heart failure outcomes in patients with hypertrophic cardiomyopathy and a left ventricular ejection fraction of 50% or higher","authors":"Y. Qian , R.-Y. Shi , J.-Y. Zheng , B.-H. Chen , D.-A. An , Y. Zhou , J.-Y. Xiang , R. Wu , L. Zhao , L.-M. Wu","doi":"10.1016/j.crad.2024.09.022","DOIUrl":"10.1016/j.crad.2024.09.022","url":null,"abstract":"<div><h3>Aim</h3><div>Identifying high-risk hypertrophic cardiomyopathy (HCM) patients for heart failure (HF) is a challenge. Previous studies noted left atrial (LA) abnormalities in HCM patients, but the predictive value of LA strain and strain rate for HF in those with left ventricular ejection fraction (LVEF) ≥ 50% remains unclear. Our study aimed to explore if LA strain and strain rate predict HF-related outcomes in HCM patients with LVEF ≥ 50%.</div></div><div><h3>Materials and Methods</h3><div>In this retrospective study, 284 patients aged 51 (range 40–62), 68% male, were studied. 34 experienced HF-related outcomes including death to HF, NYHA III-IV class progression, and HF worsening leading to hospitalization. LA strain and rate were analyzed using cardiac magnetic resonance (CMR) feature tracking technique. ROC curves, Kaplan–Meier curves, violin plot, LASSO analysis, forest plot, and Cox regression were used. The strength of the association was represented as HR∗, where HR∗ is defined as hazard ratio (HR) when the HR > 1 and as 1/HR when HR < 1.</div></div><div><h3>Results</h3><div>After adjusting for the NYHA classification and the extent of LV-LGE, the booster strain (HR∗: 1.094; 95% CI: 0.845–0.989; <em>p</em> = 0.026) and booster strain rate (HR∗: 2.593; 95% CI: 1.369–4.910; <em>p</em> = 0.003) were significantly associated with HF-related events. Reservoir strain, conduit strain, and their respective strain rates did not emerge as independent predictors for HF-related outcomes.</div></div><div><h3>Conclusion</h3><div>LA booster strain and strain rate showed a stronger association with HF-related outcomes, highlighting significant functional changes in the LA. Identifying these parameters as key predictors underscores their importance in managing particularly in HCM patients with LVEF ≥ 50%.</div></div>","PeriodicalId":10695,"journal":{"name":"Clinical radiology","volume":"80 ","pages":"Article 106716"},"PeriodicalIF":2.1,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predicting neuroendocrine neoplasm grade with dual tracer positron emission tomography/computed tomography (PET/CT) using 18F-fluorodeoxyglucose (18F-FDG) and 18F–AlF-NOTA-octreotide: a lesion-based analysis 利用18F-氟脱氧葡萄糖（18F-FDG）和18F-AlF-NOTA-奥曲肽的双示踪剂正电子发射断层扫描/计算机断层扫描（PET/CT）预测神经内分泌肿瘤的分级：基于病灶的分析

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-05 DOI: 10.1016/j.crad.2024.09.021

Y. Liu, S. Jiao, L. Liu, S. Yao, S. Xu

AIM

The aim of this study was to investigate the ability of dual tracer positron emission tomography/computed tomography (PET/CT) using ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) and ¹⁸F–AlF-NOTA-octreotide (¹⁸F-OC) in predicting neuroendocrine neoplasm (NEN) grade. The lesions that have been histologically confirmed were accurately located using both ¹⁸F-FDG and ¹⁸F-OC PET/CT.

MATERIALS AND METHODS

For each lesion, the standardized uptake value (SUV)_max was measured, and tumor-to-background ratio was calculated by dividing the SUV_max by the SUV_mean of background tissue at the two scans. SUVR was calculated by dividing the SUV_max of the lesion at ¹⁸F-OC PET/CT by the SUV_max at ¹⁸F-FDG PET/CT. For evaluating the correlation between continuous variables and lesion grade, the Spearman rank correlation test was used. Receiver operating characteristic (ROC) curve was used to evaluate the performance of PET/CT parameter in discriminating lesions of different grades.

RESULTS

A total of 49 patients (22 males, 27 females; mean age: 56.5 ± 14.3 years; range: 14–85 years) and 65 lesions were included in this study. A substantial correlation was observed between SUVR and lesion grade (rho = −0.655, p < 0.001), better than other PET/CT parameters. For discriminating G1/2 neuroendocrine tumor (NET) from G3 NET and neuroendocrine carcinoma (NEC), SUVR had the largest area under ROC curve (AUC) of 0.88. With the cut-off value of 2.217, we got the best Youden's index, 0.668. For discriminating G1/2/3 NET from NEC, SUVR and OC SUV_max had the largest AUC of 0.923. With the cut-off value of OC SUV_max of 4.35, we got the best Youden's index, 0.805.

CONCLUSION

This study suggests that ¹⁸F-FDG and ¹⁸F-OC PET/CT are complementary in evaluating the grade of NEN and that SUVR is a promising tool for predicting NEN grade.

目的研究使用18F-氟脱氧葡萄糖（18F-FDG）和18F-AlF-NOTA-奥曲肽（18F-OC）的双示踪剂正电子发射断层扫描/计算机断层扫描（PET/CT）预测神经内分泌肿瘤（NEN）分级的能力。材料与方法测量每个病灶的标准化摄取值（SUV）max，用两次扫描的SUVmax除以背景组织的SUVmean，计算出肿瘤与背景的比值。18F-OC PET/CT 的病灶 SUVmax 除以 18F-FDG PET/CT 的 SUVmax 即为 SUVR。在评估连续变量与病变分级之间的相关性时，使用了斯皮尔曼秩相关检验。结果本研究共纳入 49 名患者（22 名男性，27 名女性；平均年龄：56.5 ± 14.3 岁；范围：14-85 岁）和 65 个病灶。观察发现，SUVR 与病变分级之间存在显著相关性（rho = -0.655，p <0.001），优于其他 PET/CT 参数。在鉴别 G1/2 神经内分泌肿瘤（NET）与 G3 神经内分泌肿瘤（NET）和神经内分泌癌（NEC）方面，SUVR 的 ROC 曲线下面积（AUC）最大，为 0.88。截断值为 2.217 时，尤登指数（Youden's index）最佳，为 0.668。在区分 G1/2/3 NET 和 NEC 时，SUVR 和 OC SUVmax 的 AUC 最大，为 0.923。结论本研究表明，18F-FDG 和 18F-OC PET/CT 在评估 NEN 分级方面具有互补性，而且 SUVR 是预测 NEN 分级的有效工具。

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引用次数: 0

Simple imaging biomarker predicts survival in anal squamous cell cancer treated with curative intent: a UK cohort study 简单的成像生物标志物可预测接受根治性治疗的肛门鳞状细胞癌患者的生存率：一项英国队列研究

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-05 DOI: 10.1016/j.crad.2024.10.001

A. Wale , L. Bernier , D. Tait , S. Rao , G. Brown

AIM

This study aimed to determine the prognostic significance of length of tumour (mrT stage) and depth of extramural spread (mrEMS) in anal squamous cell cancer (SCC) treated by chemoradiation with curative intent. Locally advanced anal SCC (T3-4 N+) have poorer prognosis, but it is unknown whether the lateral spread of the tumour (extramural spread beyond the bowel wall) also confers poor prognosis in anal SCC, as it does for rectal cancer. T stage and mrEMS can be readily assessed by pelvic magnetic resonance imaging (MRI) routinely undertaken to stage anal SCC.

MATERIALS AND METHODS

125 patients were included. Baseline mrT, mrN and mrEMS were assessed with response to chemoradiation and outcomes. Receiver operating curve (ROC) curve was used to determine a binary cut-off for mrEMS according to 3-year progression- free survival (PFS).

Results

43% were mrT3-4 and 38% were mrEMS_poor at baseline. 87% achieved mrCR. 3-year PFS and overall survival (OS) were 70.6% and 82%. On univariate analysis worse 3-year PFS was seen for mrT3-4 (HR 3.105), mrEMS_poor (HR 4.924) and failure to achieve mrCR (HR 20.591). By univariate analysis, worse 3-year OS was seen for mrT3-4 (HR 4.134), mrEMS_poor (HR 10.251) and failure to achieve mrCR (HR 19.289). On multivariate analysis, only mrEMS_poor and failure to achieve mrCR remained prognostic. mrN was not prognostic.

Conclusion

MrEMS_poor is a simple prognostic imaging biomarker for poorer survival which can be readily assessed by radiologists on routine imaging. mrEMS should be considered as a future stratification variable to identify high-risk SCC and consider escalation of treatment and surveillance strategies.

研究目的：本研究旨在确定肛门鳞状细胞癌（SCC）中肿瘤长度（mrT分期）和壁外扩散深度（mrEMS）对治愈性化疗的预后意义。局部晚期肛门鳞状细胞癌（T3-4 N+）的预后较差，但肿瘤的侧向扩散（肠壁外扩散）是否也会像直肠癌一样导致肛门鳞状细胞癌的预后较差，目前尚不清楚。T分期和mrEMS可以通过盆腔磁共振成像（MRI）进行常规评估，以对肛门SCC进行分期。对基线 mrT、mrN 和 mrEMS 与化疗反应和预后进行了评估。根据 3 年无进展生存期（PFS），采用接收者操作曲线（ROC）曲线确定 mrEMS 的二元截断值。87%的患者达到了 mrCR。3年无进展生存期（PFS）和总生存期（OS）分别为70.6%和82%。单变量分析显示，mrT3-4（HR 3.105）、mrEMSpoor（HR 4.924）和未达到 mrCR（HR 20.591）的患者 3 年 PFS 较差。通过单变量分析，mrT3-4（HR 4.134）、mrEMSpoor（HR 10.251）和未能达到 mrCR（HR 19.289）的 3 年 OS 较差。结论mrEMSpoor是一个简单的预后成像生物标志物，放射科医生可通过常规成像轻松评估其不良生存率。mrEMS应被视为未来的分层变量，以识别高风险SCC并考虑升级治疗和监测策略。

{"title":"Simple imaging biomarker predicts survival in anal squamous cell cancer treated with curative intent: a UK cohort study","authors":"A. Wale , L. Bernier , D. Tait , S. Rao , G. Brown","doi":"10.1016/j.crad.2024.10.001","DOIUrl":"10.1016/j.crad.2024.10.001","url":null,"abstract":"<div><h3>AIM</h3><div>This study aimed to determine the prognostic significance of length of tumour (mrT stage) and depth of extramural spread (mrEMS) in anal squamous cell cancer (SCC) treated by chemoradiation with curative intent. Locally advanced anal SCC (T3-4 N+) have poorer prognosis, but it is unknown whether the lateral spread of the tumour (extramural spread beyond the bowel wall) also confers poor prognosis in anal SCC, as it does for rectal cancer. T stage and mrEMS can be readily assessed by pelvic magnetic resonance imaging (MRI) routinely undertaken to stage anal SCC.</div></div><div><h3>MATERIALS AND METHODS</h3><div>125 patients were included. Baseline mrT, mrN and mrEMS were assessed with response to chemoradiation and outcomes. Receiver operating curve (ROC) curve was used to determine a binary cut-off for mrEMS according to 3-year progression- free survival (PFS).</div></div><div><h3>Results</h3><div>43% were mrT3-4 and 38% were mrEMS<sub>poor</sub> at baseline. 87% achieved mrCR. 3-year PFS and overall survival (OS) were 70.6% and 82%. On univariate analysis worse 3-year PFS was seen for mrT3-4 (HR 3.105), mrEMS<sub>poor</sub> (HR 4.924) and failure to achieve mrCR (HR 20.591). By univariate analysis, worse 3-year OS was seen for mrT3-4 (HR 4.134), mrEMS<sub>poor</sub> (HR 10.251) and failure to achieve mrCR (HR 19.289). On multivariate analysis, only mrEMS<sub>poor</sub> and failure to achieve mrCR remained prognostic. mrN was not prognostic.</div></div><div><h3>Conclusion</h3><div>MrEMS<sub>poor</sub> is a simple prognostic imaging biomarker for poorer survival which can be readily assessed by radiologists on routine imaging. mrEMS should be considered as a future stratification variable to identify high-risk SCC and consider escalation of treatment and surveillance strategies.</div></div>","PeriodicalId":10695,"journal":{"name":"Clinical radiology","volume":"80 ","pages":"Article 106718"},"PeriodicalIF":2.1,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The variability in interpretation of colonic codes in CT colonography reporting: a single-centre experience CT 结肠造影报告中结肠代码解释的差异性：单中心经验。

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology

Pub Date : 2024-10-03 DOI: 10.1016/j.crad.2024.09.019

C. Clarke, A. Gangi-Burton

Aim

Although standardised summary codes to classify colonic findings (C-codes) on computed tomography colonography (CTC) have been used for several years, there is no clear guidance on how these codes should be interpreted. The aims of this study were to (1) establish CTC C-code demographics and reporting practice at our hospital and (2) determine the agreement between CTC reporters when using C-codes.

Materials and Methods

Waiving ethical approval, this online questionnaire study invited all radiologists, reporting radiographers and radiology trainees who reported CTC at our hospital between 22/02/2023 and 05/03/2023. In total 20 questions were developed with 9 questions on demographics and reporting practice followed by 11 case scenarios. Agreement between participants for the case scenarios was calculated using Fleiss kappa and mean pairwise agreement.

Results

18/21 (85.7%) of participants completed the questionnaire. The majority of respondents reported using C-codes “always” (17/18, 94.4%). Overall agreement for the 11 case scenarios was fair [0.39 (95% CI 0.38–0.41)] with a mean pairwise agreement of 46.9%. Agreement was significantly greater for reporters with ≤ 1000 than > 1000 CTC experience (p < 0.001), those who reported diminutive polyps than those who did not (p < 0.001), and adequate than inadequate case scenarios (p < 0.001).

Conclusion

This questionnaire study demonstrates variation with how C-codes are interpreted at our institution. We suggest a national survey to determine whether this is a widespread issue and to inform development of formal implementation guidance within the UK Bowel Cancer Screening Programme.

目的：尽管用于对计算机断层扫描结肠成像（CTC）结肠检查结果进行分类的标准化摘要代码（C代码）已使用多年，但对于如何解释这些代码却没有明确的指导。本研究的目的是：(1) 确定本医院的 CTC C 代码人口统计学和报告实践；(2) 确定 CTC 报告人在使用 C 代码时的一致性：在未获得伦理批准的情况下，本在线问卷调查研究邀请了所有在 2023 年 2 月 22 日至 2023 年 3 月 5 日期间在我院报告 CTC 的放射科医生、放射科报告技师和放射科实习生。共设计了 20 个问题，其中 9 个问题涉及人口统计学和报告实践，其后是 11 个病例情景。使用弗莱斯卡帕（Fleiss kappa）和平均配对同意度计算了参与者之间对病例情景的同意度：18/21（85.7%）名参与者完成了问卷调查。大多数受访者表示 "总是 "使用 C 代码（17/18，94.4%）。11 个案例情景的总体一致性尚可[0.39 (95% CI 0.38-0.41)]，平均配对一致性为 46.9%。CTC 经验≤ 1000 次的报告者与经验＞ 1000 次的报告者（P＜0.001）、报告息肉变小的报告者与未报告息肉变小的报告者（P＜0.001）、病例情景充分的报告者与病例情景不充分的报告者（P＜0.001）之间的一致性明显更高：这项问卷调查研究表明，本机构对 C 代码的解释存在差异。我们建议进行一次全国性调查，以确定这是否是一个普遍问题，并为英国肠癌筛查计划的正式实施指南的制定提供信息。

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引用次数: 0